Hi, I’m Tori and I’m a doctor of physical therapy who specializes in pelvic dysfunction which means
I treat things that can go wrong around the pelvis, and this includes sexual dysfunction.
Today I am excited to share a requested video all about retrograde ejaculation—what is it,
what causes it, how do I know if it’s happening to me, and what can be done to treat it!
In order to understand retrograde ejaculation, it’s helpful to have a basic understanding of
male pelvic anatomy and how ejaculation happens under normal circumstances.
We’ll begin by discussing just that, before defining retrograde ejaculation,
talking more about how it presents and what causes it, and how it can potentially be treated.
Timestamps and links to any studies or resources mentioned today can be found
in the description below and, without further adieu, let’s get into it!
Let’s begin by looking at a cross section of the male pelvis. Imagine that this man is standing in
*this* direction (to the right) and has been cut down the center. His pubic bone,
penis, and testicles are here, towards the front of his body,
and his tailbone and buttocks are here, towards the back of his body.
Alright, now that we’re oriented, let’s name some of these internal
structures and talk about their functions! Here you have the bladder, where urine or pee
is stored. When it is time to urinate, urine exits the bladder through the urethra,
which is the tube that connects the bladder to the head of the penis. The urethra is also the
same tube that allows semen or ejaculate to exit through the head of the penis.
Here you can see a testis, or one of the testicles, where sperm are created. On top
of the testis rests the epididymus, which stores sperm. One of the interesting things about male
ejaculate is that sperm—true semen—only make up about 5% of male ejaculate. The other 95%
comes from elsewhere in the male pelvis, which we’ll talk about in a second!
So testis, epididymus, and here you can see
another tube—the vas deferens—which connects the epididymus to the urethra.
As we travel along the vas deferens, you’ll find the seminal vesicles—the
seminal vesicles contribute fluid to male ejaculate that gives the sperm
energy and makes it easier for them to swim—and
it’s actually the seminal fluid that makes up most of male ejaculate, about 70% give or take
So testis, epididymus, vas deferens, seminal vesicles,
and the fusion of the seminal vesicles and vas deferences actually create ejaculatory ducts,
which empty the semen from the epididymus and the fluid from the seminal vesicles
into the urethra to be expelled out of the head of the penis during ejaculation
Finally, we have this structure, sitting at the base of the bladder and surrounding some
of the urethra—the prostate. The male prostate is a reproductive organ that contains smooth muscle,
which means the muscle's movement is involuntary—much like your stomach muscles
and intestinal muscles. Its main roles are to secrete prostatic fluid into male ejaculate—this
prostatic fluid accounts for the remaining 25% of that ejaculate—and to create muscular contractions
that help propel semen into the urethra and then out of the head of the penis during ejaculation.
Let’s review these structures and their functions one more time before we start
talking about retrograde ejaculation. We’ve got the bladder, which stores urine,
and the urethra, which connects the bladder to the head of the penis. When a male urinates,
urine empties from the bladder through the urethra out of the penis into the rest of the world.
We’ve got the testis, which creates sperm, the epididymus, which houses sperm, the vas deferens,
which, during ejaculation, allow the sperm to travel from the epididymus to the urethra,
as we travel along the vas deferens we find the seminal vesicle,
which adds seminal fluid to the semen—and, the seminal vesicles with the vas deferens, create
an ejaculatory duct that helps propel that ejaculate into the urethra. There,
the ejaculate will travel through the prostate, the gland underneath the bladder that surrounds
part of the urethra. The prostate adds prostatic fluid to the semen, and its muscular contractions
help to propel the semen through the urethra, down to the head of the penis and out into the world.
But, when that complete ejaculate makes its way into the urethra,
what stops it from traveling up into the bladder, instead of down towards the head of the penis?
Now that we’ve got a good understanding of male pelvic anatomy and what happens during ejaculation
under normal circumstances, let’s talk about what happens during retrograde ejaculation.
At the base of the bladder, right where the urethra and bladder connect, there is a muscle,
a sphincteric muscle, that opens and closes pending on what’s going on. This muscle is called
the internal urethral sphincter, and, just like the muscle in the prostate,
it is made of smooth muscle, which means it is not under your voluntary control.
During normal ejaculation, this sphincter closes, which forces ejaculate to take the path of least
resistance, down the urethra and out of head of the penis. Retrograde ejaculation is secondary
to some sort of dysfunction in this sphincter muscle, some sort of dysfunction in the internal
urethral sphincter. During retrograde ejaculation, this sphincter is either open or not fully closed,
which allows all or some of the ejaculate to travels backwards into the bladder. Retrograde,
in this context, literally means backward, or reverse. Backward ejaculation going up into
the bladder, instead of forward ejaculation going down through the head of the penis.
Retrograde ejaculation does not affect someone’s ability to have and maintain an erection,
or their ability to orgasm; however, someone with retrograde ejaculation
might experience orgasms that produce very little ejaculate,
because most of that ejaculate went up into the bladder instead of down through the head
of the penis, or they might experience what is known as a dry orgasm—an orgasm that results in
no ejaculate whatsoever, because all of the ejaculate went up into the bladder.
This is an important distinction—dry orgasm and retrograde ejaculation are not
the same thing. While retrograde ejaculation can cause dry orgasm, not all dry orgasms are
caused by retrograde ejaculation. A more palpable example of this might be what is
known as a radical prostatectomy, or the surgical removal of the prostate in its
entirety. When the prostate is surgically removed, the person will experience dry
orgasms after surgery because the prostate and seminal vesicles—which together create 95%
of male ejaculate—will be gone, the remaining urethra will sewn to the base of the bladder,
and, while the testes will still create sperm, the vas deferens will no longer connect to the
urethra. Hence the resulting dry orgasms that have nothing to do with retrograde ejaculation.
So, someone with retrograde ejaculation might experience orgasms that produce very
little ejaculate or truly dry orgasms. They might also experience cloudy urine when they pee
after they orgasm, because that urine contains both pee
and ejaculate. That’s actually how retrograde ejaculation is formally diagnosed—a physician
will ask you to urinate so that your bladder is empty, then to masturbate until you reach orgasm,
and then to pee into a cup, so that your urine sample can be tested for the presence of semen.
Finally, someone with retrograde ejaculation
might experience male infertility, because very little to no sperm are
ejaculated, which could make achieving pregnancy traditionally very difficult or impossible.
Okay, now that we know what retrograde ejaculation is and how it presents,
let’s talk about why it might happen. Recall that retrograde ejaculation is secondary to some
sort of dysfunction in that sphincter muscle that lives at the base of the bladder—known
as the internal urethral sphincter. So when we ask, “what causes retrograde
ejaculation,” we’re really asking, “what causes internal urethral sphincter dysfunction?”
And the answer is usually one of three things: One—surgery that either damages the internal
urethral sphincter muscle itself, or damages the nerves that are in charge of that muscle.
Think pelvic surgeries—like bladder surgery, prostate surgery, or even surgeries that are
secondary to pelvic cancers, like testicular surgeries, or colorectal surgeries. It’s also
worth mentioning that some spinal surgeries could affect the internal urethral sphincter, because
most muscles are innervated by certain spinal segments—said another way,
our spinal cord is in charge of most of our muscles, so a spinal surgery that involves the
lower spine could affect the nerves that are in charge of the internal urethral sphincter.
Two—A medical condition that causes nerve damage to the nerves in charge of the internal urethral
sphincter—think spinal cord injury, multiple sclerosis, Parkinson’s disease, diabetes,
or other conditions that affect nerve health. Finally, three—retrograde ejaculation can be a
side-effect of certain medications that are used to treat high blood pressure, enlarged prostate,
anxiety, depression, and psychosis. If you’re curious about what medications might cause
retrograde ejaculation, I’ll include a list of some in the description below.
Alright, now that we know what retrograde ejaculation is, how it presents,
and what might cause it, let’s end by discussing how it might be treated.
First of all, it’s important to understand that true retrograde
ejaculation that is formally diagnosed by a physician is not a serious medical issue
and does not cause you or your body any physical harm. That being said,
usually treatment is sought when retrograde ejaculation is resulting in male infertility.
So, we talked about how surgeries or medical conditions that damage the
internal urethral sphincter muscle itself or damage the nerves in charge of that muscle can
cause retrograde ejaculation. If that muscle and/or nerve damage is on the more mild side,
your doctor might treat you with a drug that improves internal urethral sphincter muscle tone,
or improves the ability of that sphincter muscle to close, like pseudoephedrine or imipramine.
If that muscle and/or nerve damage is on the more severe side, it may not be possible to restore
normal ejaculation; however, if this is the case and you’re seeking treatment to improve fertility,
please do seek out a fertility specialist! There are assisted fertilization procedures that exist
for people with retrograde ejaculation that can absolutely result in normal, healthy pregnancies!
Finally, we also talked about how certain medications can cause retrograde
ejaculation. If this is the case, your doctor might switch you to a different
medication in order to restore normal ejaculation.
So, to recap, retrograde ejaculation happens when semen travels up into the bladder, instead of down
towards the head of the penis. Usually someone experiencing retrograde ejaculation will also
experience orgasms that produce either very little ejaculate, or are truly dry orgasms. Because of
this, when that person urinates after an orgasm, that urine will likely be cloudy, because
it has both pee and semen in it. Also, due to the orgasms that produce little to no ejaculate,
someone with retrograde ejaculation may struggle with fertility. Finally,
true retrograde ejaculation is secondary to internal urethral sphincter dysfunction
and is not a serious medical condition nor does it cause the body any physical harm.
On that note, thank you so much for watching. This was a fun request video to make, so thank
you also so much for requesting! I hope that this video was helpful and gave you a better
understanding of your body or someone you love’s body. If you enjoyed it, please do give it
a thumbs up, share it, and if you didn’t, do give it a thumbs down and let me know what I
can do to improve in the future. Feel free to comment absolutely anything down below—your
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today’s video, but also about life things. Thank you again so much for watching,
I hope that you have a wonderful rest of your day and I will see you in the next video. Bye!